| Objective:To study the difference of the effect of the automatic control mode and the fixed pressure control mode on the patients with obstructive sleep apnea hypopnea syndrome and to evaluate the difference between the two treatment modes.Methods: According to the objective of research and the PICO rule of meta analysis,provide the inclusion and exclusion criteria,then provide a scientific and comprehensive retrieval strategy.We searched the electronic databases MEDLINE,EMBASE, Web of science,the Cochrane Library,CNKI and Wanfang database,and manual search Chinese Journal of Tuberculosis and Respiratory Diseases and Chinese Journal of Otorhinolaryngology Head and Neck Surgery. We extracted data,evaluated quality according to the quality evaluation criteria. Heterogeneity across studies was determined, and sensitivity analyses were conducted and compliance of patients AHI,ESS scale changes were extracted .To use meta analysis related software pool data of reasearches,and calculate the combined two categorical variable data and 95%CI,and to conduct statistical test of two categorical variable data.Results: A total of 31 articles were searched and retrieved, all of which were rand-omized controlled trials.1. Comparison of clinical outcomes1.lApnea Hypopnea Index(AHI)The result showed that there was no significant difference in post-treatment AHI between auto-CPAP and fixed CPAP([0.27;95%CI(-0.27,0.80);Z=0.98;P=0.33]).In the subgroup of 30<AHI?40 and 50?60,the result showed the post-treatment AHI of auto-CPAP group is more than fixed CPAP group([MD=0.39;95%CI(0.28,0.51);Z=6.71 ;P<0.00001]and[MD=0.25;95%CI(0.00,0.50);Z=1.95;P=0.05]),the result of other subgroups showed that there was no significant difference in post-treatment AHI between auto-CPAP and fixed CPAP [MD=0.25;95%CI(-0.33,0.84);Z=0.85;P=0.40].1.2 Epworth Sleepiness Scale(ESS)The total result showed that there was significant difference in post-treatment ESS between auto-CPAP and fixed CPAP,and post-treatment ESS of auto-CPAP group is less than fixed CPAP group[MD=-0.38;95%CI(-0.46,-0.29); Z=8.59;P<0.00001],and the result of subgroup of 30<AHI?40 and 40<AHI?50 showed that post-treatment ESS of auto-CPAP group is less than fixed CPAP group ([MD=-0.50;95%CI(-0.61,-0.40);Z=9.60;P<0.00001]and[MD=-0.30;95%CI(-0.50,-0.11);Z=3.10;P=0.002]),but the result of subgroup of 30<AHI?40 is just the opposite[MD=0.76;95%CI(0.33,1.20);Z=3.42:P=0.0006].2.Treatment adherenceThe total result showed that there was significant difference in treatment adherence between auto-CPAP and fixed CPAP,and the treatment adherence of auto-CPAP group is better than the fixed CPAP [MD=0.23h hour per night;95%CI(0.10,0.35);Z=3.42;P=0.0006],among the subgroups,the result of subgroup of 20<AHI?30 and 30<AHI?40 showed that the treatment adherence of auto-CPAP group is better than the fixed CPAP([MD=0.52 hour per night;95%CI(0.38,0.66);Z=7.24;P<0.00001]and[MD=0.20 hour per night;95%CI(0.14,0.26);Z=6.70;P<0.0001]),and the other subgroups showed there are no significant difference in treatment adherence.3.Quality of lifeThe result showed that there was no significant difference in post-treatment Sleep Apnea Quality of Life Index(SAQLI).Functional Outcomes of Sleep Questionnaire(FOSQ) and Mos 36-item short-form health survey Vitality(SF-36 Vitality) between auto-CPAP and fixed CPAP(([MD=0.01;95%CI(-0.08,0.09);Z=0.14;P=0.89]and[MD=-0.13;95%CI(-0.66,0.41);Z=0.46;P=0.65]and[MD=-0.39;95%CI(-1.52,0.75);Z=0.67;P=0.50]).Conclusions:Compared to fixed CPAP,auto-CPAP improved post-treatment ESS and treatment compliance,and there is no significant difference in post-treatment AHI.And in terms of quality of life,there is no significant difference in SAQLI and FOSQ and SF-36 Vailty. |
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